EP3525727B1 - Arthrodesis plate - Google Patents
Arthrodesis plate Download PDFInfo
- Publication number
- EP3525727B1 EP3525727B1 EP18709020.4A EP18709020A EP3525727B1 EP 3525727 B1 EP3525727 B1 EP 3525727B1 EP 18709020 A EP18709020 A EP 18709020A EP 3525727 B1 EP3525727 B1 EP 3525727B1
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- EP
- European Patent Office
- Prior art keywords
- section
- arthrodesis plate
- anchoring
- arthrodesis
- proximal
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Links
- 208000037873 arthrodesis Diseases 0.000 title claims description 41
- 238000004873 anchoring Methods 0.000 claims description 45
- 230000001174 ascending effect Effects 0.000 claims description 3
- 230000004927 fusion Effects 0.000 claims description 2
- 230000000295 complement effect Effects 0.000 claims 1
- 210000000988 bone and bone Anatomy 0.000 description 19
- 239000007943 implant Substances 0.000 description 19
- 210000001503 joint Anatomy 0.000 description 7
- 210000001145 finger joint Anatomy 0.000 description 6
- 238000000034 method Methods 0.000 description 4
- 239000011248 coating agent Substances 0.000 description 3
- 238000000576 coating method Methods 0.000 description 3
- 239000007921 spray Substances 0.000 description 2
- 229910001069 Ti alloy Inorganic materials 0.000 description 1
- 230000010256 bone deposition Effects 0.000 description 1
- 230000008468 bone growth Effects 0.000 description 1
- 229910000389 calcium phosphate Inorganic materials 0.000 description 1
- 239000001506 calcium phosphate Substances 0.000 description 1
- 235000011010 calcium phosphates Nutrition 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 210000004553 finger phalanx Anatomy 0.000 description 1
- 230000006870 function Effects 0.000 description 1
- 208000014674 injury Diseases 0.000 description 1
- 230000008407 joint function Effects 0.000 description 1
- 238000003801 milling Methods 0.000 description 1
- 230000000399 orthopedic effect Effects 0.000 description 1
- 239000002245 particle Substances 0.000 description 1
- 230000000630 rising effect Effects 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 210000002435 tendon Anatomy 0.000 description 1
- 230000008733 trauma Effects 0.000 description 1
- 230000003144 traumatizing effect Effects 0.000 description 1
- QORWJWZARLRLPR-UHFFFAOYSA-H tricalcium bis(phosphate) Chemical compound [Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O QORWJWZARLRLPR-UHFFFAOYSA-H 0.000 description 1
Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
- A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
- A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
- A61B17/80—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates
- A61B17/8061—Cortical plates, i.e. bone plates; Instruments for holding or positioning cortical plates, or for compressing bones attached to cortical plates specially adapted for particular bones
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/3011—Cross-sections or two-dimensional shapes
- A61F2002/30112—Rounded shapes, e.g. with rounded corners
- A61F2002/30136—Rounded shapes, e.g. with rounded corners undulated or wavy, e.g. serpentine-shaped or zigzag-shaped
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30108—Shapes
- A61F2002/30199—Three-dimensional shapes
- A61F2002/30261—Three-dimensional shapes parallelepipedal
- A61F2002/30265—Flat parallelepipeds
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2002/30001—Additional features of subject-matter classified in A61F2/28, A61F2/30 and subgroups thereof
- A61F2002/30621—Features concerning the anatomical functioning or articulation of the prosthetic joint
- A61F2002/30622—Implant for fusing a joint or bone material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2/30771—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves
- A61F2002/30904—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth applied in original prostheses, e.g. holes or grooves serrated profile, i.e. saw-toothed
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/30767—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
- A61F2002/3093—Special external or bone-contacting surface, e.g. coating for improving bone ingrowth for promoting ingrowth of bone tissue
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
- A61F2/02—Prostheses implantable into the body
- A61F2/30—Joints
- A61F2/42—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes
- A61F2/4241—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers
- A61F2002/4243—Joints for wrists or ankles; for hands, e.g. fingers; for feet, e.g. toes for hands, e.g. fingers for interphalangeal joints, i.e. IP joints
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
- A61F2310/00—Prostheses classified in A61F2/28 or A61F2/30 - A61F2/44 being constructed from or coated with a particular material
- A61F2310/00005—The prosthesis being constructed from a particular material
- A61F2310/00011—Metals or alloys
- A61F2310/00023—Titanium or titanium-based alloys, e.g. Ti-Ni alloys
Definitions
- an arthrodesis plate for joint stiffening, in particular on finger joints, has a proximal and a distal anchoring area, which are mechanically rigidly connected to one another.
- Joint prostheses and osteosynthesis plates are used in orthopedic and trauma surgery. The latter are also used in a special application for the planned stiffening (arthrodesis) of damaged joints.
- arthrodesis planned stiffening
- the attachment of such implants by the surgeon should be as quick, simple and minimally invasive as possible, whereby arthrodesis plates must also be anchored to the affected bone in such a way that forces between bone and implant are reliably and permanently transferred.
- prostheses for finger joints are anchored in the medullary canal, for example, without screws.
- Implants for arthrodesis are usually screwed to the bone from the outside.
- the palmar or dorsal approach usually required for the anchoring methods mentioned also carries the risk of injuring the flexor and/or extensor tendons.
- the joint is not dissected. Instead, the device of this disclosure grips the finger bones separated by the joint to be stiffened in order to stiffen the joint in this way.
- the US 2010/0125301 A1 discloses a surgical device with two legs and a bridge therebetween that functions similarly to a surgical clip.
- the present invention is based on the object of creating an arthrodesis plate, especially for finger joints, which is improved in terms of its handling during surgical attachment and in terms of its anchoring.
- the arthrodesis plate according to the invention is used for joint stiffening, particularly on finger joints, but also on other joints that predominantly have a hinge joint function. It has a proximal and a distal anchoring area that are mechanically rigid with one another are connected. According to the invention, the arthrodesis plate is characterized in that at least one outer contour of one of the two anchoring areas has a wave-shaped sagittal cross section (i.e. a wave-shaped cross section in a plane that is parallel to the sagittal plane).
- wave-shaped includes, in addition to continuous (for example sinusoidal) wave crests and troughs, also other rest-shaped, for example roof-shaped or sawtooth-shaped contours.
- the outer contour of the anchoring area does not necessarily have to run in round, constant wave crests and troughs.
- the rising and descending edges of the wave-shaped outer contour can also be designed to be straight, partially straight, even wave-shaped and/or discontinuous in any desired manner.
- the outer contour of the anchoring area does not have to be continuously curved in the geometric sense in the area of its high and low points, but it can also be designed to be discontinuous.
- the high and low points of the outer contour can also have the shape of an edge, so that the wave-shaped cross section takes the shape of a corner or tip and represents a punctiform or sharp-edged change in direction.
- the wavy outer contour according to the invention can be produced technically, for example, by applying a coating to an initially flat outer contour, for example using a plasma spray process. If the plasma spray process is controlled in such a way that different coating thicknesses are achieved at different points in the anchoring area, a wave-shaped contour can be created.
- the shape of a wave crest i.e. a locally highest area of the outer contour
- the shape of a wave crest can be rounded in some way, but also, for example, angular or with another discontinuously curved surface.
- the wave troughs i.e. the locally deepest areas of the outer contour.
- the arthrodesis plate according to the invention designed in this way, is set up for the following and thus enables the anchoring of an implant according to the invention (in particular also for the arthrodesis of a distal interphalangeal joint or a proximal interphalangeal joint) in the implants to be connected to one another mechanically by means of the arthrodesis plate according to the invention (rigid for arthrodesis).
- a bone preferably lying in the frontal plane of the finger bone and approximately Insert a flat slot from the medial or lateral side (running through its central axis) - which in the other direction (lateral or medial) particularly preferably does not go completely through the bone.
- the surgeon can now insert one of the two anchoring areas (with a transverse cross-section that is preferably wider (in the medio-lateral direction) than high (in the palmar-dorsal direction), in particular a flat rectangular transverse cross-section) into this incision from the same side (medial or lateral). He only has to take into account fewer relevant structures on the medial or lateral side of the finger. This means there is no risk of traumatizing the palmar or dorsal structures as with conventional implants.
- the width (height) of the flat slot must be designed by the operator to be (slightly) smaller than the height of preferably several of the cross sections of the anchoring area (transversely according to the invention, preferably less high than wide).
- the two anchoring areas which are connected to the two bone ends in an angle-stable and pull-out manner are, according to the invention, mechanically rigidly connected to one another, namely at 180° (i.e. in a straight line) to one another or alternatively at any angle (in particular 30°).
- the implant according to the invention rigidly bridges the two bone ends for arthrodesis.
- the two anchoring areas of the arthrodesis plate according to the invention are in particular set up for anchoring in a flat slot (which is to be made by a surgeon in the bone to be treated), namely by press fit (press fit or press fit), namely by (preferably several) cross sections of the respective anchoring area have a greater height than the height (width) of the respective slot.
- the arthrodesis plate according to the invention is therefore particularly designed for anchoring in a flat slot in each of the two bone ends in the frontal plane of the finger bone and running approximately through its central axis by press fit.
- This anchoring is further promoted according to the invention in that at least one outer contour of one of the two anchoring areas has a wave-shaped sagittal cross-section in the sense of the present invention.
- This can, for example, also be zigzag-shaped with straight ascending flanks and straight descending flanks.
- This wave-shaped cross section is designed in particular to press its wave crests into the cut surfaces or boundary surfaces of the flat slot. This can strengthen the press fit locally, namely at the wave crests - and also ensure a positive fit by pressing the wave crests into the cut surfaces.
- an arthrodesis plate is preferred in which both the top and bottom of the anchoring areas have a wave-shaped sagittal cross-section - and can thus press into the upper and lower cut surface of the flat slot over the entire surface (i.e. preferably over the entire length in the longitudinal direction of the implant, namely usually in the proximal-distal direction and / or over the entire width of the implant, namely usually in the lateral direction). .
- the wave-shaped sagittal cross section of the top and bottom run parallel to one another at least in sections, preferably overall. This results in a wave-shaped sagittal cross-section not only of an outer contour of the anchoring area, but of the anchoring area as a whole.
- an arthrodesis plate 2 is shown.
- the arthrodesis plate 2 is used for joint stiffening, particularly on finger joints (not shown). It has a proximal anchoring area 4 and a distal anchoring area 6 as well as a shaft area 8 which mechanically rigidly connects the two anchoring areas to one another.
- the two anchoring areas 4, 6 have transverse cross sections (one is in Figure 1c shown), the wider (b, in lateral direction) are as high (h, in palmar-dorsal direction).
- the outer contours 10, 12 of the two anchoring areas 4, 6 have a wave-shaped cross section overall in planes parallel to the sagittal plane ( Figure 1a ). This is zigzag-shaped with straight ascending flanks 10 and straight descending flanks 12. This wave-shaped cross section is in particular also designed to press its "wave crests" 14 into the flat cutting surfaces 16 of a flat slot (17; shown only schematically in dashed lines). This can promote a press fit locally, namely at the wave crests 14, and also ensure a positive fit with the slot 17 by pressing the wave crests 14 into the cut surfaces 16.
- Both the top and the bottom of the anchoring areas 4, 6 have the wave-shaped sagittal cross section 10, 12 overall: the top and bottom run almost completely parallel to one another.
- Each transverse cross section (one is in Figure 1c shown) of the two anchoring areas 4, 6 is rectangular, with corners of some of the rectangular transverse cross sections having chamfers 18 (radiuses (not shown) are alternatives according to the invention), namely in the area of all wave crests 14.
- the volume of the two anchoring areas 4, 6 extends in a straight line in the proximal-distal direction with straight side edges 20 ( Figure 1b ).
- the volume of the shaft area also extends in a straight line in the proximal-distal direction with straight side edges 20 in one direction and aligned with the direction of extension of the volume of the two anchoring areas, namely with common straight side edges 20.
- the shaft area can be in proximal- distal direction have a kink in its extension, which connects the two anchoring areas in the sagittal plane ( Figure 1a ) oriented at an angle to each other (which can preferably be 1° to 40° or 5° to 35° or 30°, in particular for arthrodesis on proximal interphalangeal joint - or 1° to 50° or 5° to 45° or 30° to arthrodesis at the distal interphalangeal joint).
- an implant is created that is particularly suitable for arthrodesis of the interphalangeal joints, since in this area arthrodesis of finger joints is usually carried out in such a dimensioned flexion position.
- the implant 2 shown is intended as a permanent implant and is made of a titanium alloy for this purpose.
- the surfaces are rough (R a > 4) to promote bone deposition and growth.
- the surfaces are coated with a growth-promoting coating (not shown; for example calcium phosphate).
- the implant 2 shown has the following dimensions, which have proven suitable for use as an arthrodesis plate on the DIP joint.
- the thickness h of the overall flat rectangular cross section ( Figure 1c ) of the implant 2 is 1.6 mm (preferably between 1.4 and 1.8 mm), the width b is 7 mm (preferably between 6 and 8 mm).
- the total length of the implant 2 is 26 mm (preferably between 20 and 30 mm).
- the teeth or wave crests 14 protrude beyond the planes of the top sides 22 by 0.5 mm (preferably between 0.2 and 1.0 mm), the wave troughs are 0.5 mm deep (preferably between 0.1 and 1.0 mm ).
- the flanks 10, 12 have an angle of inclination of 30° (preferably between 20° and 40°) to the planes of the top sides 22 (frontal planes).
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- Health & Medical Sciences (AREA)
- Orthopedic Medicine & Surgery (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Public Health (AREA)
- Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- General Health & Medical Sciences (AREA)
- Molecular Biology (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Neurology (AREA)
- Cardiology (AREA)
- Oral & Maxillofacial Surgery (AREA)
- Transplantation (AREA)
- Vascular Medicine (AREA)
- Prostheses (AREA)
- Roof Covering Using Slabs Or Stiff Sheets (AREA)
Description
Erfindungsgemäß ist eine Arthrodeseplatte, zur Gelenksversteifung insbesondere an Fingergelenken, mit einem proximalen und einem distalen Verankerungsbereich, die mechanisch starr miteinander verbunden sind.According to the invention, an arthrodesis plate, for joint stiffening, in particular on finger joints, has a proximal and a distal anchoring area, which are mechanically rigidly connected to one another.
In der orthopädischen und Unfallchirurgie finden Gelenksprothesen ebenso Anwendung wie Osteosyntheseplatten. Letztere werden in einer speziellen Anwendung auch zur geplanten Versteifung (Arthrodese) von beschädigten Gelenken verwendet. Die Anbringung solcher Implantate durch den Operateur sollte möglichst schnell, einfach und minimal invasiv sein, wobei auch Arthrodeseplatten so an den betroffenen Knochen zu verankern sein müssen, dass Kräfte zwischen Knochen und Implantat zuverlässig und dauerhaft übertragen werden.Joint prostheses and osteosynthesis plates are used in orthopedic and trauma surgery. The latter are also used in a special application for the planned stiffening (arthrodesis) of damaged joints. The attachment of such implants by the surgeon should be as quick, simple and minimally invasive as possible, whereby arthrodesis plates must also be anchored to the affected bone in such a way that forces between bone and implant are reliably and permanently transferred.
Prothesen auch für Fingergelenke werden bekanntlich zum Beispiel im Markraum, ohne Schrauben, verankert. Implantate zur Arthrodese werden üblicherweise von außen an den Knochen geschraubt. Der für die genannten Verankerungsmethoden üblicherweise notwendige palmare oder dorsale Zugang birgt ferner die Gefahr, die Beuge- und/oder Strecksehnen zu verletzen.As is well known, prostheses for finger joints are anchored in the medullary canal, for example, without screws. Implants for arthrodesis are usually screwed to the bone from the outside. The palmar or dorsal approach usually required for the anchoring methods mentioned also carries the risk of injuring the flexor and/or extensor tendons.
Gleiches trifft auch für die Knochenfixations- bzw. Knochenfusionsvorrichtung der
Der vorliegenden Erfindung liegt die Aufgabe zu Grunde, eine Arthrodeseplatte insbesondere für Fingergelenke zu schaffen, die bezüglich ihrer Handhabung während der operativen Anbringung und bezüglich ihrer Verankerung verbessert ist.The present invention is based on the object of creating an arthrodesis plate, especially for finger joints, which is improved in terms of its handling during surgical attachment and in terms of its anchoring.
Diese Aufgabe wird erfindungsgemäß von einer Arthrodeseplatte mit den Merkmalen des Anspruchs 1 gelöst. Vorteilhafte Ausgestaltungen sind in den Unteransprüchen angegeben.This object is achieved according to the invention by an arthrodesis plate with the features of claim 1. Advantageous refinements are specified in the subclaims.
Die erfindungsgemäße Arthrodeseplatte dient zur Gelenksversteifung insbesondere an Fingergelenken, aber auch an anderen Gelenken, die überwiegend Scharniergelenksfunktion haben. Sie weist einen proximalen und einen distalen Verankerungsbereich auf, die mechanisch starr miteinander verbunden sind. Erfindungsgemäß ist die Arthrodeseplatte dadurch gekennzeichnet, dass mindestens eine Außenkontur eines der beiden Verankerungsbereiche einen wellenförmigen Sagittal-Querschnitt hat (also einen wellenförmigen Querschnitt in einer Ebene, die parallel zur Sagittalebene liegt).The arthrodesis plate according to the invention is used for joint stiffening, particularly on finger joints, but also on other joints that predominantly have a hinge joint function. It has a proximal and a distal anchoring area that are mechanically rigid with one another are connected. According to the invention, the arthrodesis plate is characterized in that at least one outer contour of one of the two anchoring areas has a wave-shaped sagittal cross section (i.e. a wave-shaped cross section in a plane that is parallel to the sagittal plane).
Im Sinne der vorliegenden Erfindung umfasst der Begriff "wellenförmig" neben stetigen (beispielsweise sinusförmigen) Wellenbergen und -tälern auch andere rastenförmige, zum Beispiel dachförmige oder sägezahnförmige Konturen. Das bedeutet, dass die Außenkontur des Verankerungsbereichs nicht unbedingt in runden, stetigen Wellenbergen und -tälern verlaufen muss. Stattdessen können die aufsteigenden und absteigenden Flanken der wellenförmigen Außenkontur auch geradlinig, bereichsweise geradlinig, selbst wellenförmig und/oder in beliebiger Weise unstetig ausgebildet sein. Anders ausgedrückt muss die Außenkontur des Verankerungsbereiches im Bereich seiner Hoch- und Tiefpunkte im geometrischen Sinne nicht stetig gekrümmt sein, sondern sie kann auch unstetig ausgebildet sein. Die Hoch- und Tiefpunkte der Außenkontur können also auch die Gestalt einer Kante haben, so dass der wellenförmige Querschnitt die Form einer Ecke oder Spitze einnimmt und eine punktförmige bzw. scharfkantige Richtungsänderung darstellt. So kann die erfindungsgemäß wellenförmige Außenkontur technisch zum Beispiel dadurch erzeugt werden, dass auf eine zunächst ebene Außenkontur eine Beschichtung aufgetragen wird, zum Beispiel mittels Plasma-Spray-Verfahren. Wird das Plasma-Spray-Verfahren so gesteuert, dass sich unterschiedliche Beschichtungsstärken an unterschiedlichen Stellen des Verankerungsbereiches einstellen, lässt sich eine wellenförmige Kontur erzeugen. Auch hier kann, abhängig von der Form der aufgetragenen Partikel, die Form eines Wellenbergs (also eines lokal höchsten Bereiches der Außenkontur) irgendwie gerundet, aber auch zum Beispiel eckig oder mit sonst wie unstetig gekrümmter Oberfläche ausgebildet sein. Entsprechendes gilt für die Wellentäler (also die lokal tiefsten Bereiche der Außenkontur).In the sense of the present invention, the term “wave-shaped” includes, in addition to continuous (for example sinusoidal) wave crests and troughs, also other rest-shaped, for example roof-shaped or sawtooth-shaped contours. This means that the outer contour of the anchoring area does not necessarily have to run in round, constant wave crests and troughs. Instead, the rising and descending edges of the wave-shaped outer contour can also be designed to be straight, partially straight, even wave-shaped and/or discontinuous in any desired manner. In other words, the outer contour of the anchoring area does not have to be continuously curved in the geometric sense in the area of its high and low points, but it can also be designed to be discontinuous. The high and low points of the outer contour can also have the shape of an edge, so that the wave-shaped cross section takes the shape of a corner or tip and represents a punctiform or sharp-edged change in direction. The wavy outer contour according to the invention can be produced technically, for example, by applying a coating to an initially flat outer contour, for example using a plasma spray process. If the plasma spray process is controlled in such a way that different coating thicknesses are achieved at different points in the anchoring area, a wave-shaped contour can be created. Here too, depending on the shape of the applied particles, the shape of a wave crest (i.e. a locally highest area of the outer contour) can be rounded in some way, but also, for example, angular or with another discontinuously curved surface. The same applies to the wave troughs (i.e. the locally deepest areas of the outer contour).
Die erfindungsgemäße Arthrodeseplatte ist, in dieser Weise ausgestaltet, auf Folgendes eingerichtet und ermöglicht so die Verankerung eines erfindungsgemäßen Implantats (insbesondere auch für die Arthrodese eines distalen Interphalangealgelenkes oder eines proximalen Interphalangealgelenkes) in den mechanisch mittels der erfindungsgemäßen Arthrodeseplatte (zur Arthrodese starr) miteinander zu verbindenden Knochenenden auf folgende Weise: in das dem Gelenkdefekt zugewandte sowohl proximale als auch distale Knochenende (der durch das Implantat starr miteinander zu verbindenden Knochen) kann der Operateur (zum Beispiel mittels Fräse oder oszillierender Säge) einen (vorzugsweise in der Frontalebene des Fingerknochens liegenden und ungefähr durch dessen Mittenachse verlaufenden) ebenen Schlitz von medial oder lateral einbringen - der in die andere Richtung (lateral oder medial) besonders bevorzugt nicht ganz durch den Knochen hindurch geht. In diesen Schnitt kann nun der Operateur von derselben Seite (medial oder lateral) einen der beiden Verankerungsbereiche (mit vorzugsweise breiterem (in medio-lateraler Richtung) als hohem (in palmar-dorsaler Richtung), insbesondere flach rechteckigem Transversalquerschnitt)) einführen. Dabei hat er dort medial oder lateral am Finger nur weniger relevante Strukturen zu berücksichtigen. Er läuft also nicht Gefahr, wie bei herkömmlichen Implantaten die palmar oder dorsal liegenden Strukturen zu traumatisieren. Beim Einführen des Verankerungsbereichs von medial oder lateral in den ebenen Schlitz entsteht nun eine (insbesondere in der Sagittalebene) winkelstabile Verbindung zwischen dem Implantat und dem Knochenende - und überraschenderweise sogar auch eine gegen Auszugskräfte feste Verbindung - nämlich aufgrund von "Pressfit" (oder, in ingenieurstechnischen Begriffen, aufgrund von Presspassung): die Weite (Höhe) des ebenen Schlitzes ist dazu vom Operateur (geringfügig) kleiner auszubilden als die Höhe vorzugsweise mehrerer der (erfindungsgemäß transversal vorzugsweise weniger hoch als breit ausgebildeten) Querschnitte des Verankerungsbereichs. Diese soweit beschriebene Prozedur (Anbringen eines ebenen Schlitzes in das Knochenende; Einführen von medial oder lateral des Verankerungsbereichs in den ebenen Schlitz) wird am anderen Knochenende für den anderen Verankerungsbereich des Implantats - zum Anbringen des Implantats zur Arthrodese - wiederholt. Die auf diese Weise winkelstabil und auszugsfest mit den beiden Knochenenden verbundenen beiden Verankerungsbereiche sind erfindungsgemäß mechanisch starr miteinander verbunden, und zwar unter 180° (also in gerader Linie) zu einander oder alternativ in einem beliebigen Winkel (insbesondere 30°). In dieser Weise montiert, überbrückt das erfindungsgemäße Implantat die beiden Knochenenden starr zur Arthrodese.The arthrodesis plate according to the invention, designed in this way, is set up for the following and thus enables the anchoring of an implant according to the invention (in particular also for the arthrodesis of a distal interphalangeal joint or a proximal interphalangeal joint) in the implants to be connected to one another mechanically by means of the arthrodesis plate according to the invention (rigid for arthrodesis). Bone ends in the following way: in the both proximal and distal bone ends facing the joint defect (of the bones to be rigidly connected to one another by the implant), the surgeon can (for example using a milling machine or oscillating saw) insert a bone (preferably lying in the frontal plane of the finger bone and approximately Insert a flat slot from the medial or lateral side (running through its central axis) - which in the other direction (lateral or medial) particularly preferably does not go completely through the bone. The surgeon can now insert one of the two anchoring areas (with a transverse cross-section that is preferably wider (in the medio-lateral direction) than high (in the palmar-dorsal direction), in particular a flat rectangular transverse cross-section) into this incision from the same side (medial or lateral). He only has to take into account fewer relevant structures on the medial or lateral side of the finger. This means there is no risk of traumatizing the palmar or dorsal structures as with conventional implants. When the anchoring area is inserted from the medial or lateral side into the flat slot, an angle-stable connection (particularly in the sagittal plane) is created between the implant and the bone end - and surprisingly even a connection that is strong against pull-out forces - namely due to "press fit" (or, in engineering terms, due to press fit): the width (height) of the flat slot must be designed by the operator to be (slightly) smaller than the height of preferably several of the cross sections of the anchoring area (transversely according to the invention, preferably less high than wide). This procedure described so far (making a flat slot in the end of the bone; inserting medial or lateral of the anchoring area into the flat slot) is used on the other Bone end for the other anchoring area of the implant - for attaching the implant for arthrodesis - repeated. According to the invention, the two anchoring areas which are connected to the two bone ends in an angle-stable and pull-out manner are, according to the invention, mechanically rigidly connected to one another, namely at 180° (i.e. in a straight line) to one another or alternatively at any angle (in particular 30°). When mounted in this way, the implant according to the invention rigidly bridges the two bone ends for arthrodesis.
So sind die beiden Verankerungsbereiche der erfindungsgemäßen Arthrodeseplatte insbesondere eingerichtet auf Verankerung in jeweils einem ebenen Schlitz (der von einem Operateur im zu behandelnden Knochen anzubringen ist), und zwar durch Pressfit (Presssitz oder Presspassung), indem nämlich (vorzugsweise mehrere) Querschnitte des jeweiligen Verankerungsbereichs eine größere Höhe aufweisen als die Höhe (Weite) des jeweiligen Schlitzes.The two anchoring areas of the arthrodesis plate according to the invention are in particular set up for anchoring in a flat slot (which is to be made by a surgeon in the bone to be treated), namely by press fit (press fit or press fit), namely by (preferably several) cross sections of the respective anchoring area have a greater height than the height (width) of the respective slot.
So ist die erfindungsgemäße Arthrodeseplatte also insbesondere eingerichtet für die Verankerung in je einem ebenen Schlitz in den beiden Knochenenden in der Frontalebene des Fingerknochens und ungefähr durch dessen Mittenachse verlaufend durch Pressfit. Diese Verankerung wird erfindungsgemäß weiter begünstigt dadurch, dass mindestens eine Außenkontur eines der beiden Verankerungsbereiche einen im Sinne der vorliegenden Erfindung wellenförmigen Sagittal-Querschnitt hat. Dieser kann zum Beispiel auch zickzackförmig sein mit geraden aufsteigenden Flanken und geraden absteigenden Flanken. Dieser wellenförmige Querschnitt ist insbesondere eingerichtet, mit seinen Wellenbergen in die Schnittflächen oder Grenzflächen des ebenen Schlitzes hineinzudrücken. Dies kann den Pressfit lokal, nämlich bei den Wellenbergen, verstärken - und zudem durch Hineindrücken der Wellenberge in die Schnittflächen auch für einen Formschluss sorgen.The arthrodesis plate according to the invention is therefore particularly designed for anchoring in a flat slot in each of the two bone ends in the frontal plane of the finger bone and running approximately through its central axis by press fit. This anchoring is further promoted according to the invention in that at least one outer contour of one of the two anchoring areas has a wave-shaped sagittal cross-section in the sense of the present invention. This can, for example, also be zigzag-shaped with straight ascending flanks and straight descending flanks. This wave-shaped cross section is designed in particular to press its wave crests into the cut surfaces or boundary surfaces of the flat slot. This can strengthen the press fit locally, namely at the wave crests - and also ensure a positive fit by pressing the wave crests into the cut surfaces.
Erfindungsgemäß bevorzugt ist zur Begünstigung der Pressfitverankerung eine Arthrodeseplatte, bei der sowohl die Oberseite als auch die Unterseite der Verankerungsbereiche insgesamt einen wellenförmigen Sagittal-Querschnitt haben - und sich so vollflächig (also vorzugsweise über die gesamte Länge in Längsrichtung des Implantats, nämlich üblicherweise in proximal-distaler Richtung und/oder über die gesamte Breite des Implantats, nämlich üblicherweise in lateraler Richtung) in die obere und untere Schnittfläche des ebenen Schlitzes eindrücken können.According to the invention, to promote press-fit anchoring, an arthrodesis plate is preferred in which both the top and bottom of the anchoring areas have a wave-shaped sagittal cross-section - and can thus press into the upper and lower cut surface of the flat slot over the entire surface (i.e. preferably over the entire length in the longitudinal direction of the implant, namely usually in the proximal-distal direction and / or over the entire width of the implant, namely usually in the lateral direction). .
Besonders bevorzugt ist es dann, dass der wellenförmige Sagittal-Querschnitt der Oberseite und der Unterseite mindestens abschnittsweise, vorzugsweise insgesamt, parallel zueinander verlaufen. So ergibt sich nicht nur ein wellenförmiger Sagittal-Querschnitt einer Verankerungsbereich-Außenkontur, sondern des Verankerungsbereichs insgesamt.It is then particularly preferred that the wave-shaped sagittal cross section of the top and bottom run parallel to one another at least in sections, preferably overall. This results in a wave-shaped sagittal cross-section not only of an outer contour of the anchoring area, but of the anchoring area as a whole.
Diese und andere Merkmale der Erfindung werden im Folgenden mit Bezug auf die beigefügten Abbildungen von Ausführungsbeispielen der Erfindung beschrieben. Darin zeigen:
-
Figur 1a eine Darstellung einer erfindungsgemäßen Arthrodeseplatte in Seitenansicht von lateral auf eine Sagittalebene, -
Figur 1b eine Darstellung der erfindungsgemäßen Arthrodeseplatte in Draufsicht von vorn auf eine Frontalebene, -
Figur 1c eine geschnittene Darstellung der erfindungsgemäßen Arthrodeseplatte als Schnitt in einer Transversalebene in Ansicht von distal, und -
eine räumliche Ansicht der erfindungsgemäßen Arthrodeseplatte nachFigur 2Figur 1 .
-
Figure 1a a representation of an arthrodesis plate according to the invention in a side view from the side on a sagittal plane, -
Figure 1b a representation of the arthrodesis plate according to the invention in a top view from the front on a frontal plane, -
Figure 1c a sectional representation of the arthrodesis plate according to the invention as a section in a transverse plane in a distal view, and -
Figure 2 a spatial view of the arthrodesis plate according to the inventionFigure 1 .
In den
Die Außenkonturen 10, 12 der beiden Verankerungsbereiche 4, 6 haben insgesamt in Ebenen parallel zur Sagittalebene einen wellenförmigen Querschnitt (
Jeder transversale Querschnitt (einer ist in
Das Volumen der beiden Verankerungsbereiche 4, 6 ist in proximal-distaler Richtung geradlinig erstreckt mit geraden Seitenkanten 20 (
Das abgebildete Implantat 2 ist als Dauerimplantat vorgesehen und besteht zu diesem Zweck aus einer Titanlegierung. Die Oberflächen sind rau ausgebildet (Ra > 4), um Anlagerung und Anwachsen von Knochen zu begünstigen. Die Oberflächen sind mit einer wachstumsfördernden Beschichtung (nicht dargestellt; zum Beispiel Calciumsphosphat) beschichtet.The
Das abgebildete Implantat 2 hat folgende Abmessungen, die sich für die Verwendung als Arthrodeseplatte am DIP-Gelenk bewährt haben. Die Stärke h des insgesamt flach rechteckigen Querschnitts (
Claims (10)
- An arthrodesis plate (2) for joint fusion, wherein the arthrodesis plate comprises:a proximal-distal direction, a longitudinal direction in the proximal-distal direction, and a medio-lateral direction,a proximal anchoring region (4) and a distal anchoring region (6) which are mechanically and rigidly connected to each other, wherein a transversal cross-section of the anchoring regions has a height (h) relative to the longitudinal direction and has a width (b) in the medio-lateral direction, wherein the width is greater than the height,characterized in thatthe proximal anchoring region (4) and the distal anchoring region (6) have an outer contour (10, 12) with an undulating cross-section in a plane parallel to the sagittal plane and/or in a transversal plane, andin that the anchoring regions (4, 6) can be introduced in a medio-lateral direction into a planar slot (17), wherein the undulating cross-section is arranged to press with its crests into the boundary surfaces of the planar slot.
- The arthrodesis plate (2) according to claim 1, characterized in that the upper side and the lower side of the anchoring regions (4, 6) have an undulating sagittal and/or transversal cross-section.
- The arthrodesis plate (2) according to claim 2, characterized in that the undulating sagittal and/or transversal cross-section of the upper side and of the lower side run parallel to one another at least in portions.
- The arthrodesis plate (2) according to any one of the preceding claims, characterized in that the undulating sagittal and/or transversal cross-section is zigzag-shaped with straight ascending flanks and straight descending flanks.
- The arthrodesis plate (2) according to any one of the preceding claims, characterized in that the transversal cross-section is rectangular.
- The arthrodesis plate (2) according to claim 5, characterized in that corners of the rectangular transversal cross-section and/or edges of the arthrodesis plate have chamfers (18) and/or roundings.
- The arthrodesis plate (2) according to any one of the preceding claims, characterized in that the volume of both anchoring regions (4, 6) in the proximal-distal direction extends in a substantially straight line or in that the two anchoring regions are oriented at an angle to one another.
- The arthrodesis plate (2) according to claim 7, characterized in that the angle is 1° to 50°, or 5° to 45°, or 30°.
- The arthrodesis plate (2) according to claim 7 or 8, characterized in that, between both anchoring regions (4, 6), a pivotable and lockable connection is formed, which makes the angle adjustable.
- The arthrodesis plate (2) according to claim 9, characterized in that the lockable connection has complementary contact surfaces lying one on top of the other, in particular with star-shaped textures about a pivot axis, and/or which can be locked in a form-fitting and/or frictionfitting manner.
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PCT/EP2018/055899 WO2018188861A1 (en) | 2017-04-11 | 2018-03-09 | Arthrodesis plate |
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EP3525727B1 true EP3525727B1 (en) | 2023-11-29 |
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ES2971037T3 (en) * | 2017-04-11 | 2024-06-03 | Link Waldemar Gmbh Co | ARTHRODESIS PLATE |
ES2971968T3 (en) | 2020-10-30 | 2024-06-10 | Link Waldemar Gmbh Co | Implantation tool for an interphalangeal implant |
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US20070282443A1 (en) * | 1997-03-07 | 2007-12-06 | Disc-O-Tech Medical Technologies Ltd. | Expandable element |
IL128261A0 (en) * | 1999-01-27 | 1999-11-30 | Disc O Tech Medical Tech Ltd | Expandable element |
US20070156241A1 (en) * | 2004-08-09 | 2007-07-05 | Reiley Mark A | Systems and methods for the fixation or fusion of bone |
CN101325927A (en) * | 2005-12-12 | 2008-12-17 | 沃尔德马连接两合公司 | Endoprosthesis with intermediate part |
DE102008039693A1 (en) | 2008-08-26 | 2010-03-11 | Normed Medizin-Technik Vertriebs-Gmbh | Wrist arthrodesis plate and assortment |
US8888826B2 (en) * | 2008-11-20 | 2014-11-18 | Mbrace, Llc | Surgical device, system and method of use thereof |
DE202009008872U1 (en) * | 2009-06-26 | 2009-09-03 | Normed Medizin-Technik Vertriebs-Gmbh | Foot surgery bone plate |
FR2957244B1 (en) * | 2010-03-09 | 2012-04-13 | Synchro Medical | ARTHRODESE IMPLANT |
US9724138B2 (en) * | 2011-09-22 | 2017-08-08 | Arthrex, Inc. | Intermedullary devices for generating and applying compression within a body |
US9474561B2 (en) * | 2013-11-19 | 2016-10-25 | Wright Medical Technology, Inc. | Two-wire technique for installing hammertoe implant |
US10080599B2 (en) * | 2014-02-27 | 2018-09-25 | SurgicalDesignInnovations | Bone fusion/fixation device and related systems and methods |
BR112014019957A2 (en) * | 2014-03-28 | 2019-09-24 | Wright Medical Tech Inc | hammer finger implant |
CN204562343U (en) * | 2015-02-09 | 2015-08-19 | 付振栋 | A kind of interphalangeal joint merges plate |
CN205339255U (en) * | 2015-12-25 | 2016-06-29 | 常州庚扬医疗科技有限公司 | Outer fixed splint admittedly of finger |
CN106344218A (en) * | 2016-08-31 | 2017-01-25 | 嘉思特华剑医疗器材(天津)有限公司 | Buckling digit joint prosthesis assembly |
ES2971037T3 (en) * | 2017-04-11 | 2024-06-03 | Link Waldemar Gmbh Co | ARTHRODESIS PLATE |
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WO2018188861A1 (en) | 2018-10-18 |
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